Iodine deficiency disorders after a decade of universal salt iodization in a severe iodine deficiency region in China.

Background & objectives: Universal salt iodization (USI) was implemented in all counties of China in 1995. This study was undertaken to assess the status of iodine deficiency disorders control and prevention after 10 years of implementation of USI in a severe iodine deficiency region in China. Methods: Thirty primary school were selected in Gansu province utilizing cluster sampling methodology for the years 1995 and 2005. In each selected school, 40 children aged 8-10 yr were randomly selected for thyroid and IQ examination, and urinary samples were collected from 12. On the spot casual urine samples and salt samples were collected from a subset of children included in the study. In 2005, casual urine samples were also collected from 50 pregnant and lactating women in each cluster. Effect of health education was studied by a combination method of giving questionnaires to and observing students and families. Results: The total goiter rates (TGR) were found to be 13.5 and 38.7 per cent in 2005 and 1995 respectively. The medians urinary iodine excretion levels of children were 191.8 and 119.9 μg/l in 2005 and 1995. The median urinary iodine excretion level of women was 161.9 μg/l. The mean intelligence quotient (IQ) was 96.9 in 2005 significantly more than that in 1997 (P<0.05). The health education pass rate of children and women were 21.1 and 51.1 per cent respectively. Interpretation & conclusion: After ten years of universal salt iodization (USI), iodine nutrition of people improved and the current iodine nutrition status of population was adequate. Decrease in TGR and increase in IQ showed that IDD control and prevention had made great progress through ten years USI, salt iodization played the key role in IDD control and prevention for sustained elimination of IDD, the programme of USI and other measures like health education should be persisted and enforced.

Pesquisa neonatal de hipotiroidismo congénito: supervisión del déficit de yodo en la provincia de Misiones / Screening neonatal for congenital hypothyroidism: surveillance of iodine deficiency in Misiones

El déficit de yodo (IDD) es un problema de la Salud Pública que afecta a millones de personas en todo el mundo y es causante de alteraciones en la neuromaduración que pueden ser evitados si se realiza una yodoprofilaxis adecuada. Objetivo: Realizar un monitoreo de IDD en la localidad de Wanda, provincia de Misiones, por su ubicación geográfica y hábitos alimentarios con posible consumo regional de sal no iodada. Se estudiaron en 502 escolares de 5 a 14 años de vida , se evaluaron: peso, talla , BMI y palpación tiroidea. En 114 de ellos se determinó la yoduria en muestras casuales de orina. Se analizaron los niveles de TSH de la pesquisa neonatal de los 18 meses previos al estudio, realizados por métodos sensibles (IFMA-DELFIA). Se aplicaron los criterios de suficiencia establecidos por la OMS/ ICCDD. Resultados: La prevalencia de bocio en la región fue de 6.2 %. Los niveles de yoduria tuvieron una mediana de 239 ug/l. El valor de TSH neonatal mediano fue 1.25 uU/ml. Sólo el 1.4 % de las muestras estaban por encima de 5 uU/ml . Cuando se aplicaron los criterios de la OMS pudo observarse que la prevalencia de bocio superaba levemente lo esperado para una zona suficiente, pero no así los niveles de ioduria ni la distribución de TSH neonatal. Conclusión: El aporte iodado de la región evaluada es suficiente como lo demuestran la ioduria y los niveles de TSH neonatal. La presencia de bociógenos como la mandioca en la dieta puede explicar el leve aumento en la prevalencia de bocio. La utilización de la pesquisa neonatal de hipotiroidismo congénito en la supervisión de la deficiencia de yodo añade un beneficio al objetivo primario que es la prevención del retraso mental.

O b j e c t i v e : To estimate the adequacy of iodide intake in Wanda Misiones through the conventional parameters of ioduria and goiter prevalence in scholars as well as with the distribution of TSH neonatal levels as performed for the hypothyroidism screening program in newborns. Population and methods: Height , and BMI and weight were assessed in 502 scholars aged 5 to 14 and expressed as SDS. In 419 of them (215 female) thyro i d volume was evaluated and classified according to WHO (9). In 114 children iodide urinary concentration was measured in casual urine samples by Sandell y Kolthof method modified by Pino (17). Neonatal screening program for congenital hypothyroidism is carried out in the region measuring TSH in filter paper samples with IFMA DELFIA. Since 2000 7.102 newborn have been screened. TSH level's distribution of the 18 months prior to this study (n 267) were evaluated. Criteria suggested by WHO to indicate iodide deficiency were applied. Results: Height, weight and BMI were normal for the chronological age according to Argentinean population parameters. Goitre prevalence was 6.2 % (7.3 % in girls and 5.3 % in boys), higher that expected for a iodide sufficient area. Iodide urine median levels were 239 ug/l with a distribution that excluded iodide deficiency. Neonatal screening program detected 5 congenital hypothyroid children out of the 7102 newborn studied. All of them were early and adequately treated. Only 1.4 % of the 267 samples were > 5 µU/ml, excluding iodide deficiency. Conclusion: Iodide intake in Wanda, Misiones, is adequate as shown by the findings of iodide urine concentration and TSH neonatal levels. A higher prevalence of goitre than expected for this situation, could be explained by dietary intake of goitrogen food as mandioca. Congenital hypothyroidism screening program in this region was extremely effective. The possibility of using its results for iodide intake supervision is an additional benefit to the one of early prevention of mental retardation.

Tiroiditis de Hashimoto en niños y adolescentes con bocio / Hashimoto´s thyroiditis in children and adolescents with goiter

Se denomina bocio al aumento de tamaño de la glándula tiroidea, que da lugar a un abultamiento en la región anterior del cuello, el agrandamiento de los lóbulos laterales de la tiroides debe ser superior al tamaño de la falange distal del dedo pulgar del paciente. La tiroiditis de Hashimoto es la inflamación crónica de la tiroides de origen autoinmunitario; cursa con bocio y puede provocar hipotiroidismo existe un hipotiroidismo, este se desarrolla en forma paulatina. El tratamiento del paciente hipotiroideo consiste en la administración de levotiroxina.

Evaluation of the effectiveness of salt iodization status in Tripura, north east India.

BACKGROUND & OBJECTIVES: Universal salt iodization programme was initiated during 1988-89 in the goitre endemic state of Tripura. However, no decline in goitre prevalence was found about a decade after the initiation of programme. The present work evaluates the quality of implementation of the salt iodization programme and the possible involvement of dietary goitrogens in the process. METHODS: The study areas were selected at random and in the selected areas only, school children were chosen purposively instead of the entire population. Iodine nutritional status was evaluated by measuring the urinary iodine excretion. The iodine content of salt collected from households was tested by iodometric titration, urinary iodine was measured by dry ashing method and thiocyanate by oxidising bromine and then developing colour by benzedine hydrochloride. RESULTS: Urinary iodine level was measured in 1,123 samples from 22 study areas. In 17 areas, the median urinary iodine values were > 100 micrograms/l indicating no biochemical iodine deficiency. However, the iodine intake of about 40 per cent of the studied population was below the cut-off level i.e., iodine level were < 100 micrograms/l. About two-thirds of salt samples were found to contain iodine less than the adequacy level of 15 ppm. Thiocyanate was present in the 1,032 urine samples studied, in different concentrations. INTERPRETATION & CONCLUSION: The people of region are exposed to inadequately iodized salt in spite of the salt iodization programme. Further, they are exposed to a thiocyanate load. This study suggests that monitoring of salt iodization programme is essential to ensure the recommended level of iodine (15 ppm) in at least 90 per cent salt samples. The goitrogenic/antithyroid potential of cyanogenic foods used in the region need to be ascertained to understand the nature of action on thyroid function.

Effects of salted food consumption on urinary iodine and thyroid function tests in two provinces in the Islamic Republic of Iran

We evaluated sources of difference in urinary iodine between two neighbouring Iranian provinces, Gilan and Mazandaran. In the cities of Rasht [Gilan] and Sari [Mazandaran], 340 and 343 participants respectively were selected by cluster sampling. Urinary iodine in Rasht was significantly higher than in Sari [31 micro g/dL versus 21 micro g/dL]. Sodium and potassium urine levels in Rasht were also higher than Sari. Mean daily intake of iodized salt and thyroid function tests were not significantly different. Average annual consumption of some salted foods was significantly higher in Rasht than Sari. We conclude that higher consumption of salted foods in Rasht is responsible for an increase in urinary iodine

Economic evaluation of water iodization program in Thailand.

In Thailand, iodine deficiency disorders (IDD) are endemic in 57 out of 75 provinces with an estimated 15 million people at risk of IDD. A three pronged control program with iodized salt, iodized water and iodized oil capsules is being implemented. The water iodization program is both school based and household based. In the household, the residents are given iodine solution, two drops of which is to be added to 10 l of drinking water. In the schools, in addition to this method, an iodinator is used. This releases a fixed amount of iodine into the drinking water. This study examines the cost of the water iodization program in Thailand for the year 1996 in terms of cost per beneficiary, cost per microg iodine consumed daily and cost per goiter person years averted. We used a discount rate of 5%. Field visit and interviews of health personnel from Ministry to village level were conducted to gather primary data. Review of existing papers and reports of the Department of Health, Government of Thailand was done for secondary data. The costs included the capital cost of equipments, initial training and the recurrent costs of potassium iodate, proportional salaries of personnel involved, monitoring and communication activities. The cost per beneficiary of school based iodinator method (US$ 0.72) and school based drop method (US$ 0.64) were similar and much higher than the household based approach (US$ 0.12). The cost per microg of iodine consumed daily was ten times higher in the school based approach (US$ 0.01) compared to the household approach (US$ 0.001). The cost per goiter case averted for the whole strategy of water iodization was US$ 194.50. Water iodization appears to be a low cost intervention. However, the need for behavioral modification raises the issue of long term sustainability.

Community based intervention of iron deficiency anemia in females and iodine deficiency disorders in school children in Lao PDR.

Under the supervision of the central and local health authorities, a pilot project was conducted in four villages in the Luangprabang Province, Lao PDR. The objective of the project was to test different regimes to supplement females with oral iron preparations to reduce iron deficient anemia (IDA) and control iodine deficiency disorders (IDD) in school children. Compared with iron sulphate tablets, iron fumerate tablets were well accepted and good compliance results were achieved. Hemoglobin concentration improved only in the group of females taking iron fumerate tablets. The goiter rate decreased from approximately 90% to about 45% for school children, regardless of whether iodine salt were used by their families or whether iodine capsules were used to treat the children. The latter attempt was hampered by the fact that also in the control village iodine fortified salt was used. This was due to a governmental attempt to control IDD nation-wide. Therefore, also in the control village a significant decrease in the goiter rate was observed.

Prophylactic use of iodized salt in pregnancy

OBJECTIVE: To study the prevalence of iodized salt prophylaxis in pregnant women. SETTING: Department of Gynaecology and Obstetrics Allied Hospital Faisalabed Pakistan. PERIOD: 1997-1998. PATIENTS: 241 women with normal and complicated pregnancies. METHOD: [i] Clinical examination and history taking [ii] Interrogation about the use of iodized salt. Out of 241 pregnant women only 14 were found to be the user of iodized salt giving the prevalence rate of iodized salt prophylaxis as 5.80%

Análise de fatores associados à recorrência de bócio pós-tiroidectomia / Analysis of the factors associated to recurrence of post-thyroidectomy goiter

Os fatores associados à recidiva de bócio pós-tiroidectomia por doença benigna da tiróoide ainda näo estäo completamente definidos, especialmente o uso profilático de hormônio tiroidiano. Objetivo. Determinar a prevalência, características e fatores associados à recorrência de bócio em pacientes submetidos à tiroidectomia por doença benigna. Métodos. Foram incluídos 66 pacientes, 53 mulheres e 13 homens (idade média = 51 anos, variaçäo = 20-82 anos) submetidos previamente (5,6 + or - 1 anos) à tiroidectomia (lobectomia, n = 50; nodulectomia, n = 5; tiroidectomia subtotal, n = 11). Na ocasiäo do estudo foi realizada ecografia de tiróide e dosagens séricas de T3, T4, TSH e anticorpos antimicrossomal. Definiu-se como recorrência de bócio a presença de volume residual >20mL e/ou novos nódulos >0,5mL à ecografia e näo previamente detectados durante a cirurgia. Resultados. SEte pacientes (10 por cento) apresentaram recorrência de bócio. O tempo de acompanhamento foi mais longo no grupo com recorrência (p < 0,5) e näo foi observada diferença em relaçäo a idade, sexo presença de história familiar de tiropatia e diagnóstico pré-operatório entre os dois grupos. Na análise de regressäo múltipla, apenas o tmepo de acompanhamento pós-tiroidectomia foi significativamente associado à recorrência de bócio (ß = 0,02;//2 = 0,16; p < 0,05), influenciando em 14 por cento a taxa de recorrência. História familiar de tiropatia, uso de hormônio tiroidiano e níveis séricos de T4 e TSE näo influenciaram a recorrência. Conclusäo. A recorrência de bócio pós-tiroidectomia por doença benigna de tiróide ocorre numa minoria de pacientes e estáa relacionada com o maior tempo de acompanhamento após a cirurgia. O uso de hormônio tiroidiano em doses näo supressiva após a cirurgia näo se relaciona à prevençäo de recorrência

Goiter in school going children in Murree Hills

In 31 schools in tehsil Murree 2860 children were examined, for presence of goitre. In girls, 47.9% had goitre while 46.5% of boys had goitre. The overall prevalence rate being 47.4%